Botulinum toxin type A in upper lid retraction of Graves' ophthalmopathy

Botulinum toxin type A (BTTA) was injected in the upper lid of 6 patients to reduce palpebral retraction due to Graves' ophthalmopathy. Five unilateral and one bilateral (all female) cases constitute the present series. Injection of 2.5 to 7.5 units of BTTA in the affected lids produced ptosis of 2 to 3 mm in 5 patients. A bilateral case showed a positive but insufficient response by the third injection. An acceptable position of the affected eyelids was maintained for 1 to 8 months. The drug-effect period varied in every patient, regardless of the dose injected, amount of retraction, or endocrine status (hyper, hypo, or euthyroidism) at the moment of treatment. In 5 of 6 patients BTTA provided acceptable upper lid position without cosmetic discomfort. The early results obtained encouraged the use of botulinum toxin in this entity.